Healthcare Provider Details

I. General information

NPI: 1558435750
Provider Name (Legal Business Name): JANET SIDEBOTTOM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N DIVISION ST
AUBURN WA
98001-4939
US

IV. Provider business mailing address

4471 HALLMARK DR
BYRNES MILL MO
63051-2066
US

V. Phone/Fax

Practice location:
  • Phone: 253-545-2050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number129451
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: